Placing dental implants in microvascular bone free flaps used for reconstructing the mandible or maxilla has been previously reported. However, there is scarce information available on the restorative protocol using short dental implants placed in a deep circumflex iliac artery (DCIA) microvascular free flap and the rationale behind it. This case report describes a 18-year-old patient referred to the hospital for numbness and dull pain of the left mandible, which she observed for three months. The patient underwent mandible resection and reconstruction using the DCIA free flap due to "giant cell lesion" on the left side of the mandibular angle. Short dental implants were placed and prosthetic reconstruction of the dentition involved in the resection was performed in a young patient with two integrated abutment crowns. The placement of short dental implants did not negatively affect the vascular pedicle and vitality of free flap. In our case report, two years after the healing, excellent aesthetic and function were accomplished with the DCIA flap followed by restoration with short implants.

CMF Institute Vienna Schumanngasse 15 A 1180 Vienna Austria

Dentaris Praha Dental Clinic Olšanská 7 Prague 1300 00 Czech Republic

Department of Maxillofacial Surgery F D Roosevelt University Hospital Banská Bystrica 974 01 Slovak Republic

Department of Prosthodontics and Periodontology University of Sao Paulo Bauru School of Dentistry Bauru SP Brazil

Department of Prosthodontics Faculty of Medicine and Dentistry Palacky University Olomouc 779 00 Czech Republic

Former Head of the University Hospital for Cranio Maxillofacial and Oral Surgery Waehringer Guertel 18 201090 Vienna Austria

S DENT Dental Clinic Šancová street Bratislava Slovak Republic

See more in PubMed

Rodriguez E.D., Bluebond-Langner R., Martin M., Manson P.N. Deep circumflex iliac artery free flap in mandible reconstruction. Atlas Oral Maxillofac Surg Clin North Am. 2006;14:151–159. PubMed

Su Y.R., Ganry L., Ozturk C., Lohman R., Al Afif A., McSpadden R., Frias V., Pu J.J. Fibula flap reconstruction for the mandible: why it is still the workhorse? Atlas Oral Maxillofac Surg Clin North Am. 2023;31:121–127. PubMed

Hoffmann J., Horn D. Maxillofacial Surgery, Elsevier; 2017. Reconstruction of the Mandible; pp. 497–506.

Urken M.L., Vickery C., Weinberg H., Buchbinder D., Lawson W., Biller H.F. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch. Otolaryngol. Head Neck Surg. 1989;115:339–349. PubMed

Takushima A., Harii K., Asato H., Momosawa A., Okazaki M., Nakatsuka T. Choice of osseous and osteocutaneous flaps for mandibular reconstruction. Int. J. Clin. Oncol. 2005;10:234–242. PubMed

Mashrah M.A., Aldhohrah T., Abdelrehem A., Sakran K.A., Ahmad H., Mahran H., Abu-Lohom F., Su H., Fang Y., Wang L. Survival of vascularized osseous flaps in mandibular reconstruction: a network meta-analysis. PLoS One. 2021;16 PubMed PMC

Kakarala K., Shnayder Y., Tsue T.T., Girod D.A. Mandibular reconstruction. Oral Oncol. 2018;77:111–117. PubMed

Lonie S., Herle P., Paddle A., Pradhan N., Birch T., Shayan R. Mandibular reconstruction: meta-analysis of iliac- versus fibula-free flaps. ANZ J. Surg. 2016;86:337–342. PubMed

Khadembaschi D., Russell P., Beech N., Batstone M.D. Osseointegrated implant survival, success and prosthodontic outcomes in composite free flaps: a 10-year retrospective cohort study. Clin. Oral Implants Res. 2021;32:1251–1261. PubMed

Laverty D.P., Addison O., Wubie B.A., Heo G., Parmar S., Martin T., Praveen P., Pearson D., Newsum D., Murphy M., Bateman G. Outcomes of implant-based oral rehabilitation in head and neck oncology patients-a retrospective evaluation of a large, single regional service cohort. Int. J. Implant Dent. 2019;5:8. PubMed PMC

Al-Johany S.S., Al Amri M.D., Alsaeed S., Alalola B. Dental implant length and diameter: a proposed classification scheme. J. Prosthodont. 2017;26:252–260. PubMed

Bonfante E.A., Jimbo R., Witek L., Tovar N., Neiva R., Torroni A., Coelho P.G. Biomaterial and biomechanical considerations to prevent risks in implant therapy. Periodontol. 2000;81(2019):139–151. PubMed

Coelho P.G., Jimbo R., Tovar N., Bonfante E.A. Osseointegration: hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales. Dent. Mater. 2015;31:37–52. PubMed

Baldassarri M., Bonfante E., Suzuki M., Marin C., Granato R., Tovar N., Coelho P.G. Mechanical properties of human bone surrounding plateau root form implants retrieved after 0.3-24 years of function. J. Biomed. Mater. Res. B Appl. Biomater. 2012;100:2015–2021. PubMed

Gil L.F., Suzuki M., Janal M.N., Tovar N., Marin C., Granato R., Bonfante E.A., Jimbo R., Gil J.N., Coelho P.G. Progressive plateau root form dental implant osseointegration: a human retrieval study. J. Biomed. Mater. Res. B Appl. Biomater. 2015;103:1328–1332. PubMed

Ch'ng S., Skoracki R.J., Selber J.C., Yu P., Martin J.W., Hofstede T.M., Chambers M.S., Liu J., Hanasono M.M. Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients. Head Neck. 2016;38(Suppl 1):E321–E327. PubMed

Edher F., Nguyen C.T. Short dental implants: a scoping review of the literature for patients with head and neck cancer. J. Prosthet. Dent. 2018;119:736–742. PubMed

Frodel J.L., Jr., Funk G.F., Capper D.T., Fridrich K.L., Blumer J.R., Haller J.R., Hoffman H.T. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast. Reconstr. Surg. 1993;92:449–455. ; discussion 456-448. PubMed

Ardisson A., Senna P., Granato R., Bergamo E., Bonfante E., Marin C. Success rate of mandible implants placed in vascularized fibula bone graft: a systematic review. J. Oral Implantol. 2023;49:85–92. PubMed

Zheng H.P., Zhuang Y.H., Zhang Z.M., Zhang F.H., Kang Q.L. Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application. J. Plast. Reconstr. Aesthetic Surg. 2013;66:1256–1262. PubMed

Escandon J.M., Bustos V.P., Escandon L., Santamaria E., Gaxiola-Garcia M.A., Kushida-Contreras B.H., Forte A.J., Ciudad P., Langstein H.N., Manrique O.J. The versatility of the DCIA free flap: a forgotten flap? Systematic review and meta-analysis. J. Reconstr. Microsurg. 2022;38:378–389. PubMed

Grinsell D., Catto-Smith H.E. Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla. J. Plast. Reconstr. Aesthetic Surg. 2015;68:1044–1053. PubMed

Qu X., Zhang C., Yang W., Wang M. Deep circumflex iliac artery flap with osseointegrated implants for reconstruction of mandibular benign lesions: clinical experience of 33 cases. Ir. J. Med. Sci. 2013;182:493–498. PubMed

Sarendranath A., Khan R., Tovar N., Marin C., Yoo D., Redisch J., Jimbo R., Coelho P.G. Effect of low speed drilling on osseointegration using simplified drilling procedures. Br. J. Oral Maxillofac. Surg. 2015;53:550–556. PubMed

Broggini N., McManus L.M., Hermann J.S., Medina R.U., Oates T.W., Schenk R.K., Buser D., Mellonig J.T., Cochran D.L. Persistent acute inflammation at the implant-abutment interface. J. Dent. Res. 2003;82:232–237. PubMed

Bozkaya D., Muftu S. Efficiency considerations for the purely tapered interference fit (TIF) abutments used in dental implants. J. Biomech. Eng. 2004;126:393–401. PubMed

Dibart S., Warbington M., Su M.F., Skobe Z. In vitro evaluation of the implant-abutment bacterial seal: the locking taper system. Int. J. Oral Maxillofac. Implants. 2005;20:732–737. PubMed

Cheng Y.C., Perpetuini P., Murcko L., Hirayama M., Morgan K., Marincola M., Bonfante E.A., Bergamo E.T.P., Ewers R. Fiber-reinforced composite full-arch prosthetic reconstructions supported by three standard, short or extra-short implants: a two-center retrospective study. Clin. Oral Invest. 2023;27:4191–4203. PubMed

Urdaneta R.A., Daher S., Lery J., Emanuel K., Chuang S.K. Factors associated with crestal bone gain on single-tooth locking-taper implants: the effect of nonsteroidal anti-inflammatory drugs. Int. J. Oral Maxillofac. Implants. 2011;26:1063–1078. PubMed

Passos S.P., Gressler May L., Faria R., Ozcan M., Bottino M.A. Implant-abutment gap versus microbial colonization: clinical significance based on a literature review. J. Biomed. Mater. Res. B Appl. Biomater. 2013;101:1321–1328. PubMed

Misch C.E. ed, 3. 2007. Treatmetn Plans Related to Key Implant Positions and Implant Number, Contemporary Implant Dentistry; pp. 147–159.

Wang Y., Jiang J., Guan Y., Si M., He F. Retrospective study of short versus standard posterior implants and analysis of implant failure risk factors. Int. J. Oral Maxillofac. Implants. 2021;36:1129–1136. PubMed

Ravida A., Wang I.C., Barootchi S., Askar H., Tavelli L., Gargallo-Albiol J., Wang H.L. Meta-analysis of randomized clinical trials comparing clinical and patient-reported outcomes between extra-short (</=6 mm) and longer (>/=10 mm) implants. J. Clin. Periodontol. 2019;46:118–142. PubMed

Cheng Y.C., Perpetuini P., Marincola M., Speratti D., Murcko L., Hirayama M., Benalcazar-Jalkh E.B., Bonfante E.A. Prefabricated shouldered abutments enable successful restoration of molar crowns on implants. Clin. Implant Dent. Relat. Res. 2024;26:457–466. PubMed

Pohl V., Thoma D.S., Sporniak-Tutak K., Garcia-Garcia A., Taylor T.D., Haas R., Hammerle C.H. Short dental implants (6 mm) versus long dental implants (11-15 mm) in combination with sinus floor elevation procedures: 3-year results from a multicentre, randomized, controlled clinical trial. J. Clin. Periodontol. 2017;44:438–445. PubMed

Ku J.K., Kim I.H., Lee J.G., Kim Y.K. Long-term clinical evaluation of short implants on posterior partially edentulous areas: a 14-year retrospective study. Int. J. Oral Maxillofac. Implants. 2021;36:131–136. PubMed

Kniha K., Mohlhenrich S.C., Foldenauer A.C., Peters F., Ayoub N., Goloborodko E., Holzle F., Modabber A. Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: a three-year follow-up study. J. Cranio-Maxillo-Fac. Surg. 2017;45:474–478. PubMed

Choi J.-S., Jo Y.-J., Bang J.-A., Kim J., Oh J.-S., Moon S.-Y. Analysis of dental implant rehabilitation in the reconstructed jaw by deep circumflex iliac artery flap, a retrospective study. Appl. Sci. 2022;12:7050.